Guidelines for giving medicine aren't as simple as 'open up and say ahh'

Guidelines for giving medicine aren't as simple as 'open up and say ahh'

Strict rules regarding giving medicine to students in school might be hard for some parents to swallow, but the policies are designed to keep kids safe, say school health personnel in the Tri-State area.

School nurses in Maryland and West Virginia aren't allowed even to give students an over-the-counter pain medication such as Tylenol without written permission from a doctor. Parents who want their kids to take an over-the-counter drug during school hours, but don't want to take their kids to the doctor for a note, have to go to the school and give the medicine to the student.

"It isn't as cut and dried as it might seem to a parent," says Melinda Mallott, school health program manager for the Washington County Health Department. "We can't give a grain of salt, we can't give anything without a doctor's approval, because there are side effects to medications, including over-the-counters."

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In Pennsylvania, school nurses can administer over-the-counter medication if parents fill out a special form for non-prescription drugs, and label the original medicine bottle with the child's name and dosage information, says Penny Shives, department chair for school health services in the Chambersburg (Pa.) Area School District.

In Washington County, parents must bring a prescription and over-the-counter medications to the school health room. Over-the-counter drugs must be in their original containers, and be accompanied by a completed Physician Medication Order Form signed by the parent and child's doctor. All medications must show expiration dates. Other guidelines include:

No medication will be sent home with students.

All medications will be kept in the health office.

Parents must give the first dose of medication at home, primarily to gauge any allergic reactions, Mallott says.

The state Board of Education in West Virginia recently voted to adopt a similar medication administration policy for students. Physician-signed forms are now required for all medications, as opposed to only prescription drugs. Dietary supplements such as vitamins and herbal remedies - which must be FDA-approved - must also be accompanied by the same documentation required for other medications. Most herbal remedies, however, must be given at home. Like in Washington County, parents can personally give over-the-counter drugs (in their original pharmaceutical packaging) to their kids at school, says George Michael, director of pupil services for Berkeley County Public Schools.

"While this seems inconvenient to some, it will actually cause some children to be seen more regularly by their pediatrician or physician and provide a safer environment at school regarding this issue," says Sue Peros, president of the West Virginia Association of School Nurses. "While some parents have their children seen by the pediatrician and use over-the-counter medications safely, many rarely see a physician and 'treat' basically every symptom via the pharmacy, no matter how severe or contagious the condition. For that reason, school personnel were caught in a difficult scenario when parents were 'requesting' dosages of inappropriate treatments for children for extended periods of time without physician guidance or assessment."

Children with fevers and diarrhea or vomiting - which are often symptoms of communicable illnesses that warrant keeping kids home from school - also were repeatedly sent to school with over-the-counter remedies and instructions from the parents to give medication according to the label, she says.

In addition to over-the-counter medications, more students are taking prescription drugs today than in years past.

The West Virginia School Nurse Needs Assessment of 1990-91 showed 2,172 students were receiving long-term medications during the school day. That same survey in 2001 reflected that 8,280 students were receiving prescription medications - mainly for behavioral problems and asthma, Peros says.

The number of Washington County students taking medications at school also has increased over the past five years, but the number of times students are given medication during the school day has decreased, primarily because once-a-day medications have replaced many multiple-daily dose drugs, Mallott says. Last year, 1,562 students took medications at school, she says.

To keep pace with the demand, school health nurses in Maryland and West Virginia can train individuals without nursing degrees to administer medication. These certified medication assistants, who then work under the licenses of registered school nurses, are stationed at each school in Washington and Berkeley counties, Mallott and Michael say.

Registered nurses or licensed practical nurses are posted in all Pennsylvania schools, which have seen a decrease in the number of students taking prescription drugs during school hours, Shives says. She attributes the decrease, in part, to a medication for Attention Deficit Hyperactivity Disorder (ADHD) that can now be taken before school starts because the drug's effects last for 12 hours, Shives says.

And making healthier decisions can help cure the overuse of over-the-counter drugs at school, Peros says.

"Research proves that most headaches observed in the adolescent population during the afternoon can be controlled with 10 deep breaths and eight ounces of water, since the cause is generally dehydration and inactivity during the school day," she says. "We need to encourage our students to make healthier decisions rather than taking a pill for every ailment."